生活方式干预对糖尿病前期人群心脑血管事件和死亡的影响大庆糖尿病预防长期随访研究

目的 探讨糖尿病前期人群强化生活方式干预对心脑血管事件及死亡的长期影响.方法 1986年入选大庆市519例糖耐量正常(NGT)者和577例糖耐量减低(IGT)者.IGT者被随机分到对照组和饮食、运动或饮食加运动干预组进行6年生活方式干预.通过问卷和系统病历查阅,跟踪调查随后23年间首次心血管事件(心肌梗死、卒中)和死亡状况.结果 IGT未干预组心血管事件发生率和死亡率最高(44.44％及20.00％),NGT组最低(29.59％及7.52％),IGT干预组居二者之间(37.84％及12.53％).多因素分析调整基线年龄、性别、BMI、血压、吸烟和既往心血管事件的影响后,IGT未干预组的心血管病死亡率和心血管事件发生率为NGT组的1.89和1.38倍(HR=1.89,95％CI1.11～3.22;HR =1.38,95％CI1.01～1.90).而IGT干预组的心血管病死亡率和心血管事件发生率与正常对照组相比差异均无统计学意义(HR=1.39,95％CI0.89 ～2.18及HR=1.25,95％CI0.98～1.59).结论 IGT者心血管事件和死亡风险均显著高于NGT人群.数年生活方式干预可以减少长期心脑血管事件发生率和心血管病死亡率.     

生活方式干预对糖尿病前期人群心脑血管事件和死亡的影响大庆糖尿病预防长期随访研究北大核心CSCD

目的 探讨糖尿病前期人群强化生活方式干预对心脑血管事件及死亡的长期影响.方法 1986年入选大庆市519例糖耐量正常（NGT）者和577例糖耐量减低（IGT）者.IGT者被随机分到对照组和饮食、运动或饮食加运动干预组进行6年生活方式干预.通过问卷和系统病历查阅,跟踪调查随后23年间首次心血管事件（心肌梗死、卒中）和死亡状况.结果 IGT未干预组心血管事件发生率和死亡率最高（44.44％及20.00％）,NGT组最低（29.59％及7.52％）,IGT干预组居二者之间（37.84％及12.53％）.多因素分析调整基线年龄、性别、BMI、血压、吸烟和既往心血管事件的影响后,IGT未干预组的心血管病死亡率和心血管事件发生率为NGT组的1.89和1.38倍（HR=1.89,95％CI1.11～3.22;HR =1.38,95％CI1.01～1.90）.而IGT干预组的心血管病死亡率和心血管事件发生率与正常对照组相比差异均无统计学意义（HR=1.39,95％CI0.89 ～2.18及HR=1.25,95％CI0.98～1.59）.结论 IGT者心血管事件和死亡风险均显著高于NGT人群.数年生活方式干预可以减少长期心脑血管事件发生率和心血管病死亡率.     

预防心血管终点事件,从关注糖耐量受损开始

糖尿病患者常合并心血管疾病,预防心血管事件是糖尿病患者治疗的主要目的 之一.目前针对糖尿病患者进行强化血糖干预的临床试验表明,晚期血糖干预心血管获益不明显.研究发现,绝大部分2型糖尿病患者在诊断时已经存在明确的动脉粥样硬化,甚至在糖耐量受损(IGT)阶段大血管病变就已经存在.这提示IGT可能是血糖干预以获终点收益的最佳时机.     

良性肥胖对2型糖尿病、心血管事件和死亡的影响——大庆糖尿病预防23年随访研究

目的探讨良性肥胖对2型糖尿病、心血管事件和死亡等长期临床结局的影响。方法1986年纳入大庆市经口服葡萄糖耐量试验诊断的糖耐量正常者519名和新诊断2型糖尿病者630例,之后评估23年随访的长期临床结局。良性肥胖即超重肥胖而无代谢异常(定义为无糖尿病、高血压和高脂血症)。最终纳入682例受试者(糖耐量正常者350名和新诊断2型糖尿病者332例),根据基线状态分为正常体重无代谢异常组(211例)、超重肥胖无代谢异常组(58例)、超重肥胖伴高血压组(81例)、超重肥胖伴2型糖尿病组(109例)、超重肥胖伴高血压和2型糖尿病组(223例)。比较各组2型糖尿病、心血管事件和死亡发病率。结果23年后随访,超重肥胖无代谢异常组心血管事件和死亡发病风险与正常体重无代谢异常组相比无差异,但是其2型糖尿病发病率为正常体重无代谢异常组的2倍(24.1%、12.5/1000人年对10.9%、5.2/1000人年,P=0.01)。多因素回归分析调整了年龄、性别、吸烟史的影响后,这种差别依然存在[风险比(HR)=2.42,95%CI 1.24~4.74,P=0.01]。超重肥胖伴高血压组、超重肥胖伴2型糖尿病组及超重肥胖伴高血压和2型糖尿病组的全因死亡、心血管事件和死亡的发病风险均高于正常体重无代谢异常组,并依次递增(P<0.05)。结论良性肥胖人群长期心血管病风险和死亡与正常组无差异,但其2型糖尿病发病率显著增加。肥胖合并其他代谢紊乱人群的2型糖尿病、心血管事件和死亡的发病风险增加更甚。     

糖耐量受损转化为正常糖耐量或演变为糖尿病者血压均下降——来自大庆糖尿病研究的新发现

目的 分析大庆糖尿病预防研究中糖耐量受损(IGT)人群随访6年期间的糖耐量演变及其与血压变化的关联.方法 大庆糖尿病预防研究中有334例IGT患者未曾服用任何降血压药物,其中264例基线血压≥130/80 mm Hg(1mm Hg=0.133kPa).随机分配在对照、饮食、运动及饮食加运动干预4个组.从1986年随访到1992年.根据研究结束时口服葡萄糖耐量试验(OGTY)2h血糖水平(2hPG)分为<7.8、7.8～8.8、8.9～9.9、10.0～11.0、11.1～13.8、13.9～16.6和≥16.7mmol/L7个亚组,探讨各组血压水平的变化及其与血糖变化的关联.结果 经多因素分析调整了年龄、性别、基线体重指数及随访期体重变化等因素的影响后,1986至1992年间各组的收缩压改变分别为-2.4、0.6、7.7、4.3、1.7、-2.9、和-6.9 mm Hg,舒张压变化为-3.2、3.0、3.3、1.7、-0.7、-1.3和-3.7 mm Hg.收缩压和舒张压在演变为糖耐量正常或糖尿病者比那些仍然保持为IGT且2hPG在8.9～9.9mmol/L者显著下降(均P<0.05).264 例基线血压≥130/80 mm Hg者中血压变化更为显著.在上述各组,收缩压变化分别为-5.2、-2.6、5.2、2.3、-2.3、-4.2、-7.6 mm Hg,舒张压变化分别为-5.0、-3.7、1.5、-2.9、-4.3、-4.0和-6.0mm Hg.结论 大庆6年研究中IGT人群中血糖水平仍保持为IGT者血压有所升高.相反,IGT转化为正常糖耐量或糖尿病组血压明显下降.     

2007年成都地区糖尿病、糖尿病前期的流行病学调查

目的了解成都地区成年人DM和DM前期患病率的流行病学情况。方法用多级多层整体抽样方法,于2007年调查成都玉林、龙泉两个地区共计2248人。DM诊断采用1999年WHO标准。结果DM和DM前期的总患病率分别为11．1％、14．2％;标化后分别为8．2％、12．2％;男性DM患病率高于女性（P〈0．05）,两性问DM前期患病率无统计学差异（P〉0.05）。DM及DM前期患病率随年龄增长而增加（P〈0．05）。Logistic回归分析显示DM的危险因素有年龄、腰围、静息心率、BP和TG。DM前期危险因素分别为年龄、高血压史、静息心率、BMI、TC、血尿酸。HDL-C为保护性因素。结论成都地区的DM及DM前期患病率均较高,且有进一步增加趋势,须及时采取有效措施,干预糖代谢异常的流行。     

糖尿病前期筛查的分歧与共识

目前将糖耐量减低(IGT)和空腹血糖受损(IFG)称为糖尿病前期,处于该阶段的个体发生糖尿病和心血管疾病的风险明显增高.美国糖尿病协会强烈主张单独应用空腹血糖(FBG)定义糖代谢状态,而世界卫生组织(WHO)则极力推荐对无症状高血糖人群应用标准化的口服75 g葡萄糖耐量试验(OGTT),联合空腹和负荷后2 h血糖来定义一个个体是否存在任何程度的糖代谢紊乱.关于这个问题的争论焦点主要是测定FBG或2 h血糖的可行性.由于OGTT整个过程至少需要2 h,因此不太适合群体研究.但是单独测定FBG以定义糖代谢状况往往存在假阴性风险,而且糖负荷后2 h血糖是诊断IGT的唯一方法.基于两方面的考虑,推荐在群体中进行糖尿病前期和未诊断糖尿病筛选时,首先应用费效比合理的筛查工具确定出高危人群,然后再进行OGTT以进一步确诊.     

空腹血糖受损、糖耐量受损人群2年自然转归及其影响因素的研究

目的探讨空腹血糖受损(IFG)、糖耐量受损(IGT)人群发生糖尿病的危险性及其影响因素.方法对1999年7月～12月包钢集团公司2万余人糖尿病普查中IFG、IGT患者730人于2001年9～11月进行随访调查.测量身高、体重、腰围、血压,作过夜空腹75 g葡萄糖耐量试验,同时测定空腹胰岛素(FINS)及服糖后2 h胰岛素(PINS),血总胆固醇(TC),甘油三酯(TG),高密度脂蛋白胆固醇(HDL-C).结果随访的656人中138人发生糖尿病.其中孤立性IFG(I-IFG)糖尿病年转变率为5.1%,孤立性(I-IGT)为11.5%,IGT为14.0%,IFG/IGT为20.2%.I-IGT、IGT及IFG/IGT糖尿病年转变率明显高于I-IFG(均P＜0.001).与I-IFG比较,I-IGT发生糖尿病的危险比为2.65,IFG/IGT为5.96.I-IFG转归为糖尿病的危险因素主要是年龄(OR 1.05)和BMI(OR 1.03).I-IGT是2h血糖(OR 2.02)、家族史(OR 2.19)及腰围(OR 1.08).各项临床指标2年的变化结果转归为I-IFG、I-IGT者2年前后的年龄、体重、腰围、BMI、血压、TC均值及其肥胖、腹型肥胖、血脂代谢紊乱、高血压的患病率均比NGT转归组高;I-IFG与I-IGT比较差异无显著性.结论 I-IGT发生糖尿病的危险性明显高于I-IFG,主要危险因素为腰围、餐后血糖、家族史.I-IFG发生糖尿病的危险因素则是年龄、BMI.故对IGT应给予积极的干预治疗,而对于IFG应定期随访.     

贵阳城区新诊断糖尿病前期人群3年自然转归及影响因素分析

目的:分析贵阳城区40岁及以上新诊断糖尿病前期人群3年自然转归情况及影响因素。方法:2011年5月至2011年8月采用整群抽样方法对贵阳市云岩区某社区40岁以上常住居民10 015人进行问卷调查、体格检查,并采集血样测定空腹血糖、糖负荷后2 h血糖、血脂及HbA 1C等。于2014年对该人群进行随访,最终2...     

空腹血糖受损、糖耐量受损人群3年自然转归及其影响因素的研究

目的 探讨空腹血糖受损(IFG)、糖耐量受损(IGT)人群发生糖尿病的危险性及其影响因素. 方法对2003年4～6月朝阳市市区居民1 062人糖尿病普查中IFG、IGT患者79人于2006年4～6月进行随访调查.测量身高、体重、腰围、血压,做过夜空腹75g葡萄糖耐量试验,同时测定血总胆固醇(TC),甘油三酯(TG),高密度脂蛋白胆固醇(HDL-C).结果 随访的65人中22人发生糖尿病.其中孤立性IFG(I-IFG)糖尿病转变率为10.8%,孤立性IGT(I-IGT)为9.2%, IFG/IGT为10.4%.在不同的年龄组,随着年龄增长糖代谢异常、高血压、肥胖、脂代谢异常有增加趋势,在40岁以上人群糖代谢异常的患病率有明显增加趋势.进行单因素相关分析结果发现血糖升高可能与增龄、糖尿病(DM)家族史、劳动强度、腰围指数(WC)增加、收缩压(SBP)增加、血脂异常等相关.进行Logistic回归分析,高龄、血压升高、中心性肥胖、体力活动强度减弱均为糖尿病危险因素.结论 I-IGT、IGT/IFG人群糖尿病累计发病率明显高于I-IFG人群.增龄、向心性肥胖、高血压、体力活动减少是糖代谢异常的重要危险因素,因此控制血压、体重,增加体力活动,对糖尿病预防具有重要意义.     

Fasting blood glucose and risk of coronary heart disease, stroke, and all-cause mortality: a 17-year follow-up study of men born in 1913

This report concerns the relationship between baseline levels of fasting blood glucose (FBG) in non-diabetics and the subsequent 17-year incidence of coronary heart disease (CHD), stroke and all-cause mortality. In 1963, 973 men aged 50 years were recruited from a general Swedish urban population for a prospective study of risk factors for CHD. Eight hundred and fifty-five (88%) men agreed to participate and have been observed for 17 years. The 832 men who had no history of myocardial infarction, stroke, diabetes mellitus or who had a fasting blood glucose below 7.0 mmol/l at baseline were selected for this analysis. CHD occurred in 106 men, 35 developed a stroke and 137 died during follow-up. When quintiles and deciles of the FBG distribution were considered, no trend of 17-year incidence of CHD, stroke or death was apparent. However, for men with an FBG above the 95th percentile (greater than 5.7 mmol/l) a non-significant trend towards increasing risk was indicated.     

A cross-sectional analysis of glucose tolerance and cardiovascular disease in 67-year-old men

The relationship between degree of glucose tolerance and cardiovascular disease has been studied in a cross-sectional population survey of 644 men born in 1913, randomly sampled and examined at the age of 67. The cohort was divided into different groups according to current diagnostic criteria for diabetes and impaired glucose tolerance. An almost 2-fold higher prevalence of hypertension, myocardial infarction, angina pectoris, and congestive heart failure was found in the group with impaired glucose tolerance compared to the group with a normal glucose tolerance. Fifty per cent of the men with impaired glucose tolerance were being treated with some drug for cardiovascular disease, usually diuretics for hypertension. Intermittent claudication showed a 2.5-fold higher prevalence among the diabetic patients. A computerized 12-lead exercise-ECG test, with a unique accuracy in measuring ST-segment changes, was performed in a subset of 135 men. This showed no association between ST-segment depression and different degrees of glucose tolerance, even when accounting for confounding factors such as treatment with beta-blocker agents or digoxin, pathological Q-waves, and differences in maximal heart rate.     

Association of serum adiponectin with risk for cardiovascular events in patients with peripheral arterial disease

Objects

Adiponectin exerts anti-atherogenic and anti-inflammatory properties and may be important as a biomarker for cardiovascular disease (CVD). We examined whether serum adiponectin was linked with future cardiovascular events or all-cause death in patients with peripheral arterial disease (PAD).

Methods

The study prospectively included 468 patients (58% male) with symptomatic PAD. Serum total adiponectin was determined by an in-house immunoassay. We used Cox regression, adjusted for age, gender, BMI, systemic hypertension, smoking status, diabetes mellitus, previous myocardial infarction (MI), ankle-brachial index (ABI), symptoms of leg ischemia, total cholesterol, and use of β-blockers (BAB) and angiotensin-converting enzyme (ACE) inhibitors to assess possible relationship between serum adiponectin and time to first non-fatal cardiovascular event, and all-cause death.

Results

During the median follow-up of 3.5 years, 215 new cases of non-fatal cardiovascular events and 97 all-cause deaths were detected. Adjusted Cox-regression analysis showed that a 1 mg/l increase in serum adiponectin was associated with a decrease in the risk of non-fatal cardiovascular events to 0.68, (95% CI 0.47–0.99) in men, but not in women (HR 0.96 95% CI 0.55–1.70). The relative risk of adverse non-fatal cardiovascular events was 77% higher in male patients within the lower adiponectin tertile, when compared with those in the higher tertile (95% CI 1.05–2.97). Moreover, serum adiponectin was the only significant independent predictor of non-fatal cardiovascular events for men with severe PAD (HR = 0.37, 95% CI, 0.16–0.89; p = 0.026), whereas previous MI (p = 0.92) and ABI (p = 0.08) failed to reach statistical significance in the multivariable model.We did not obtain any significant associations between serum adiponectin and all-cause mortality. Multivariable model revealed that age and previous MI were independently associated with risk for all-cause death.

Conclusions

Lower levels of serum adiponectin were significantly associated with an increased risk for future non-fatal cardiovascular events in men with symptomatic PAD, but not in women.     

季节变化与心血管病人死亡关系调查

目的:调查我科住院心血管病人死亡与季节的关系。方法:查阅1993年1月～2004年12月12年来在我科住院死亡的269例病人资料,调查主要的5个病种死亡的季节规律性。结果:(1)季节性:心血管病人冬季死亡率最高,占36.8%(99/269,P<0.01),其他依次为春、秋、夏季;(2)冬季死亡病种:冠心病(CHD)死亡率最高,为79例,占79.8%(P<0.01),其他依次为高血压,主动脉夹层;(3)冠心病:174例CHD死亡患者中,冬季死亡率最高,为79例,占45.4%(P<0.01),其他依次是秋、春、夏季;(4)高血压:在41例高血压死亡病例中,20例死于春季,占48.8%,死亡率最高(P<0.01),其他依次是冬、秋、夏季;(5)其他:风心病15例,心肌病13例死亡病例中均以夏季死亡率最高,分别占46.7%,53.8%(P<0.01),其他依次为秋、冬、春季。结论:心血管病人的死亡率与季节变化相关,要根据其规律性,做好防治工作,降低死亡率。     

HLA–DRB1 and persistent chronic inflammation contribute to cardiovascular events and cardiovascular mortality in patients with rheumatoid arthritis

Objective

Cardiovascular (CV) disease is the most common cause of mortality in patients with rheumatoid arthritis (RA). We assessed the contribution of epidemiologic features, clinical features, routine laboratory markers of inflammation, and HLA–DRB1 alleles to CV mortality in patients with RA prospectively followed at a single referral center in Spain.

Methods

Patients fulfilling the 1987 American College of Rheumatology classification criteria for RA seen at the rheumatology outpatient clinic of Hospital Xeral‐Calde, Lugo between March and September 1996 were included. HLA–DRB1 phenotype, epidemiologic data, and clinical data were assessed at that time. Patients were prospectively followed and clinical records were examined until patient's death or September 1, 2005.

Results

A total of 182 consecutive patients were assessed. Compared with the general Spanish population, the age‐ and sex‐standardized mortality ratio by CV cause was 1.78. CV mortality adjusted by age at disease onset and sex was associated with chronic inflammation determined by C‐reactive protein level (CRP; hazard ratio [HR] 1.14, P < 0.001) and erythrocyte sedimentation rate (ESR; HR 1.05, P = 0.003). Patients with HLA–DRB1*04 shared epitope alleles (HR 4.15, P = 0.030), in particular those HLA–DRB1*0404 positive (HR 6.65, P = 0.002), had increased risk of CV mortality. Increased risk of CV events was also associated with CRP level (HR 1.09, P = 0.001), ESR (HR 1.03, P = 0.003), and HLA–DRB1*0404 (HR 4.47, P = 0.002).

Conclusion

Our results suggest that a chronically high inflammatory response in genetically predisposed individuals promotes an increased risk of CV events and CV mortality in RA.     

Uric acid,impaired fasting glucose and impaired glucose tolerance in youth with overweight and obesity

Background and aimThe relationships between uric acid (UA) and prediabetes is poorly explored in youth. We investigated the association between UA, impaired fasting glucose (IFG), impaired glucose tolerance (IGT), insulin resistance (IR) and low insulin sensitivity (IS) in youth with overweight/obesity (OW/OB).Methods and resultsA cross-sectional study was performed in 2248 youths with OW/OB (age 5–17 years). The sample was stratified in sex-specific quintiles (Q1 to Q5) of UA and the associations with fasting (FG), 2-h post-load glucose (2H-PG), IR and low IS were investigated. IR and low IS were estimated by assessment model of insulin resistance (HOMA-IR) and whole-body IS index (WBISI), respectively. IFG was defined as FG ≥ 100 < 126 mg/dL, IGT as 2H-PG ≥140 < 200 mg/dL, IR as HOMA-IR ≥75th percentile and low IS as WBISI ≤25th percentile by sex. Age, body mass index z-score, 2H-PG, HOMA-IR and WBISI, increased across sex-quintiles of UA while FG did not. The prevalence of IFG and IR were significantly increased in Q5 vs Q1 (reference quartile, P < 0.025). The prevalence of IGT increased from Q3 to Q5 vs Q1 (P < 0.025–0.0001) and that of low IS from Q2 to Q5 vs Q1 (P < 0.005–0.0001).ConclusionsIn youth with OW/OB, rates of IGT and low IS increased progressively across quintiles of UA. On the contrary, IFG and IR were associated only with the highest quintile of UA. Our data suggest that UA is a biomarker of impaired glucose metabolism prevalently in post–challenge condition rather than in fasting state.     

Relationship of elevated casual blood glucose level with coronary heart disease, cardiovascular disease and all-cause mortality in a representative sample of the Japanese population. NIPPON DATA80

Aims/hypothesis High fasting blood glucose is one of the well-known risk factors for CHD. However, in certain settings, patients cannot always be expected to fast. For example, community screenings for cardiovascular disease (CVD) risk factors in Japan are performed under non-fasting conditions to achieve high participation rates. Thus, we examined a representative cohort of the Japanese population (n = 9,444, follow-up period 17.3 years) to clarify whether high casual blood glucose (CBG) can predict CVD mortality. Methods We defined CBG groups as follows: high CBG ≥ 11.1 mmol/l or participants with a history of diabetes mellitus; borderline high, 7.77 ≤ CBG < 11.1 mmol/l; higher normal, 5.22 ≤ CBG < 7.77 mmol/l); and lower normal, CBG < 5.22 mmol/l. The multivariate-adjusted hazard ratios (HRs) for CHD, CVD and all-cause mortality were calculated. Results The crude CHD mortality rate was 0.84 per 1,000 person-years. Age- and sex-adjusted HRs for CHD mortality were high among participants with CBG levels  ≥ 7.77 mmol/l, regardless of time since last meal. Multivariate-adjusted HRs (95% CI) of CHD mortality in high and borderline high CBG groups were 2.62 (1.46–4.67) and 2.43 (1.29–4.58), respectively. Similar results were observed for both CVD and all-cause mortality. Even within the normal blood glucose range, each 1 mmol/l increase in CBG was associated with a statistically significant increase in the HR for CVD mortality (1.12, 95% CI 1.02–1.22). Population-attributable fractions of the combined groups of high and borderline high CBG for CHD, CVD and all-cause mortality were 12.0, 4.9 and 3.5%, respectively. Conclusions/interpretation Increases in CBG, even within the normal range, predict CVD mortality. Electronic supplementary material The online version of this article (doi:) contains a full list of the NIPPON DATA research group members, which is available to authorised users.